Long-term impact of vitamin k antagonist treatment on left ventricular thrombus: Insights from an ambispective study

Introduction: The optimal duration of anticoagulant therapy for patients presenting with left ventricular thrombosis (LVT) remains a matter of debate. This study was designed to evaluate both the efficacy and safety of treatment with vitamin K antagonists (VKAs), administered either until complete thrombus resolution or for a maximum treatment period of 12 months. Materials and Methods: This ambispective observational study enrolled patients diagnosed with LVT who were assessed at the Atherothrombosis Center of Policlinico Umberto I Hospital in Rome. Participants received VKA therapy until full thrombus resolution was achieved or for no longer than one year. The primary outcome measure was the rate of LVT resolution during therapy. Secondary outcomes included the occurrence of acute ischemic stroke, acute myocardial infarction, acute peripheral embolism, and both major and clinically relevant non-major bleeding events during a 12-month follow-up period. Results: Thirty-six patients were analyzed, with a median age of 65 years, and 91.7% were male. The average time in the therapeutic range was 55% (±19%). VKA monotherapy was prescribed in 41.9% of cases, whereas the remainder received combination therapy with antiplatelet agents. The cumulative proportions of patients achieving LVT resolution at 3, 6, and 12 months were 11% (95% confidence interval [CI], 3–24), 39% (95% CI, 23–55), and 71% (95% CI, 52–84), respectively. Multivariable Cox regression analysis identified reduced left ventricular ejection fraction (hazard ratio [HR], 0.36; 95% CI, 0.12–1.09) and the presence of a left ventricular aneurysm (HR, 0.42; 95% CI, 0.16–1.11) as predictors of lower likelihood of thrombus resolution. Throughout the observation period, no arterial thromboembolic events occurred; one patient experienced a major bleeding episode and another a clinically relevant non-major bleeding event. Conclusions: Incidence of LVT resolution increased progressively over the 12-month follow-up, with no arterial thromboembolic events and a low incidence of bleeding complications observed during anticoagulant therapy. Impaired left ventricular ejection fraction and the presence of ventricular aneurysm were associated with a decreased probability of thrombus resolution.